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General NPI Number Information
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NPI Number | 1770643645
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Entity Type | Organization
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Legal Business Name | GOLDEN STATE SPORTS INJURY AND ORTHOPEDIC MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 18531 ROSCOE BLVD SUITE 202
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4641
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Country | US
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Telephone | 818-998-8400
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Fax | 818-998-8404
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Provider Business Mailing Address
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Address Line | 18531 ROSCOE BLVD SUITE 202
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4641
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Country | US
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Telephone | 818-998-8400
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Fax | 818-998-8404
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD B PERELMAN
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Credential | M.D.
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Telephone | 818-998-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | C32643
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | C32643
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License Number State | CA
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